BackgroundUterine rupture classically presents with severe abdominal pain, loss of fetal station, vaginal bleeding, and shock.Case presentationWe present a case of uterine rupture presenting as significant urinary retention that occurred following a second trimester abortion induced with mifepristone and misoprostol. Uterine rupture was discovered unexpectedly on diagnostic laparoscopy. The uterine rupture was contained by dense adhesions between the omentum and bladder with the previous uterine cesarean hysterotomy scar.ConclusionThis case highlights the difficulties in diagnosis of abnormal placentation and an unusual presentation of uterine rupture. This case was managed successfully laparoscopically.

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Healthcare providers were significantly more likely to identify the symptoms and risk factors for ovarian cancer. Forty percent of women reported being at least slightly familiar with the symptoms of ovarian cancer. Women who were familiar with symptoms were significantly more likely to identify symptoms and risk factors correctly and to report symptoms immediately to a provider. Identification of symptoms among healthcare providers ranged from 59%-93%. Identification of ovarian cancer symptoms and risk factors is poor among women, and knowledge deficits are present in providers. Increasing familiarity and awareness could lead to improvements in early diagnosis.

Gynecologists commonly use hemostatic agents to control intraoperative bleeding during pelvic surgery, thereby avoiding more significant intervention. However, hemostatic agents predispose patients to infection. They appear to cause a probiotic microenvironment and impair host-defense mechanisms that contribute to bacterial proliferation and abscess formation.The primary aim of this study was to assess the association between use of gelatin-thrombin matrix and the occurrence of pelvic abscess during hysterectomy. Another aim was to investigate predictive factors for abscess formation. Data were abstracted from records of patients undergoing hysterectomy for obstetric-gynecologic pathology at a tertiary hospital between 2009 and 2012. Open, laparoscopic, robotic, and laparoscopic-assisted hysterectomies were included; vaginal hysterectomies were excluded. Charts were reviewed for surgery type, blood loss, preoperative comorbidities, drain placement, use of gelatin-thrombin matrix for bleeding, and abscess formation. The primary study outcome was pelvic abscess defined according to the following criteria: a walled-off fluid collection (observed with computed tomography scan) with fever (>38°C) or leukocytosis (>11,000/μL).Among 413 patients meeting study criteria; 213 (51%) underwent surgery for malignancy, and 166 (40%) were treated with gelatin-thrombin matrix. The rate of pelvic abscess was low (3%); nearly all abscesses occurred in patients in whom gelatin-thrombin matrix was used. Bivariate analyses showed that the following were associated with abscess formation: blood loss greater than 500 mL (odds ratio [OR], 3.9; 95% confidence interval [CI], 1.1-12.9; P = 0.021), ascites (OR, 6.5; 95% CI, 1.6-26.1; P = 0.023), drain placement (OR, 4.5; 95% CI, 1.3-5.1; P = 0.009), and use of gelatinthrombin matrix (OR, 7.0, 95% CI, 1.5-32.9; P = 0.009). In multivariable logistic regression, only gelatin-thrombin matrix use was a predictive factor for abscess formation (OR, 7.0; 95% CI, 1.5-32.9; P = 0.013).These data suggest that the liberal use of gelatin-thrombin matrix to control intraoperative hemorrhage in patients undergoing hysterectomy is not without risk. Further studies are needed to determine the true risk of abscess formation in this population and to compare the risk of abscess with that of other hemostatic agents. ABSTRACTDelay in recovery and delayed return-to-work time after gynecological surgery often exceed those expected from a medical perspective and reduce quality of life. This appears to result from a substantial variation in convalescence recommendations for the resumption of work and daily activities between different health care providers and from fragmented perioperative care. To meet the need for well-defined postoperative recovery guidelines and recommendations, a previous study used focus group discussions in women who had undergone gynecological surgery to develop an eHealth program.